Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study

BACKGROUND

Poor oral health is known to be associated with adverse outcomes, but the frequency and impact of poor oral health on older adults in the acute inpatient setting has been less well studied.

OBJECTIVES

We examined the association between oral health, frailty, nutrition and functional decline in hospitalized older adults.

DESIGN

Retrospective cross-sectional study.

SETTING AND PARTICIPANTS

We included data from 465 inpatients (mean age 79.2±8.3 years) admitted acutely to a tertiary hospital.

METHODS

We evaluated oral health using the Revised Oral Assessment Guide (ROAG), frailty using the Clinical Frailty Scale (CFS), malnutrition risk using the Nutritional Screening Tool (NST) and functional status using a modified Katz Activities of Daily Living (ADL) scale. We examined cross-sectional associations of oral health with frailty, malnutrition risk and functional decline on admission, followed by multivariate logistic regression models evaluating the association between poor oral health and the aforementioned outcomes.

RESULTS

343 (73.8%), 100 (21.5%) and 22 (4.7%) were classified as low, moderate and high risk on the ROAG, respectively. Poorer oral health was associated with greater severity of frailty, functional decline on admission and malnutrition risk. Abnormalities in ROAG domains of voice changes, swallowing difficulty, xerostomia, lips and tongue appearance were more frequently present at greater severity of frailty. Poor oral health was associated with frailty [odds ratio (OR): 1.76, 95% confidence interval (CI) 1.05-2.97; P=0.034]; malnutrition risk [OR: 2.76, 95% CI 1.46-5.19, P=0.002] and functional decline [OR: 1.62, 95% CI 1.01-2.59, P=0.046].

CONCLUSIONS

Poor oral health is significantly associated with frailty, malnutrition risk and functional decline in older inpatients. Oral health evaluation, as part of a comprehensive geriatric assessment may be a target for interventions to improve outcomes. Further research including longitudinal outcomes and effectiveness of specific interventions targeted at oral health are warranted in older adults in the inpatient setting.

[Relationship between one-stop CT spectral perfusion imaging parameters and expression of lymphatic microvessel density and vascular endothelial growth factor-C in axillary lymph nodes of rabbit VX2 breast cancer]

Objective: To analyze the correlation between quantitative parameters of one-stop spectral perfusion computed tomography imaging and the expression level of vascular endothelial growth factor-C(VEGF-C) and MLVD in metastatic lymph nodes of rabbit VX2 breast cancer. Methods: Thirty New Zealand purebred female rabbits were used to establish the lymph node metastasis model of rabbit VX2 breast cancer, one-stop spectral and perfusion CT imaging protocol was performed.The axillary lymph nodes were selected for corresponding image markers. The observed morphology of conventional HE staining and the EnVision method were used to quantitatively analyze VEGF-C expression and calculate MLVD.Pearson linear correlation was used to analyze the perfusion parameters of metastatic lymph node energy spectrum and the correlation of MLVD and VEGF-C expression. Results: Twenty-four experimental rabbits were successfully modeled and performed a one-stop CT scan on the 28th day. A total of 39 metastatic lymph nodes were included. The VEGF-C of metastatic lymph node was 20.0%±2.8%,and the MLVD was 12.5±3.5. There was a positive correlation between BF, AP(λHU), IC(VP), NIC(VP), VP(λHU) of metastatic lymph node and VEGF-C and MLVD (P<0.05). There was a positive correlation between lymph node IC(AP) and MLVD (P=0.027) and no correlation with VEGF-C expression (P=0.386).There was no correlation between BV, NIC(A)P and VEGF-C, MLVD(P>0.05). The correlation between VP(λHU) and MLVD was higher (r=0.448, P=0.001). Conclusions: One-stop CT spectral perfusion imaging quantitative parameters and pathological indicators have a good correlation, and it can reflect lymphatic vessel metastasis in lymph nodes.

[Application value on localization and evaluation of sentinel lymph nodes in early-stage breast cancer with CT lymphography]

Objective: To explore the clinical value of CT lymphography (CT-LG) on the localization and evaluation of sentinel lymph node (SLN) in patients with early-stage breast cancer. Methods: Thirty-six patients with early-stage breast cancer were enrolled in this study from September 2014 to June 2016 in the First Hospital of Zhengzhou University.The diagnoses were confirmed by puncture or local surgical pathology with negative clinical palpation of axillary lymph nodes, and sentinel lymph node biopsy (SLNB) was planned.The patients received CT-LG examination.The first one or several lymph nodes along the lymph duct draining from the injection site to axilla was/were defined as SLN(s), and the results were compared with the SLNB.Wilcoxon signed ranks test was used to compare the number of SLN detected by CT-LG and SLNB; according to the pathologic results, Student t test or chi-square test was used to compare the differences of the positive SLNs with negative ones. Results: SLNs were successfully identified in all 36 patients, 32 cases (88.9%) had high-quality images (with both SLN and lymphatic vessel visible); 36 SLNs were located by CT-guided wire with a success rate of 100%.A total of 88 SLNs were identified by CT-LG in 36 patients, and 102 SLNs were obtained by SLNB (Z=-2.646, P=0.008). The long-short diameter ratio (L/S) of SLN obtained by SLNB was significantly smaller than that of CT-LG (1.7±0.3 vs 1.9±0.4, t=2.880, P=0.004). Compared with pathology, CT-LG showed 21 positive SLNs and 67 negative SLNs, and the short diameter of positive SLNs was bigger than that of negative ones[(5.9±2.1) vs (4.8±1.8) mm, t=2.235, P=0.028]. Of 67 negative SLNs, 61(91.04%) appeared homogenously contrast agent filling, and 13(61.90%) of the 21 positive SLNs were found filling defect changes, and the differences in filling defect changes between positive and negative SLNs were statistically significant (χ(2)=26.479, P<0.001). Conclusion: CT-LG can accurately locate the SLN for early-stage breast cancer, and both the short diameter and filling defect changes can help evaluate the status of SLN.

Effect of heparin-superoxide dismutase on γ-radiation induced DNA damage in vitro and in vivo

The effects of heparin-superoxide dismutase (SOD) conjugate (heparin-SOD) on γ-radiation induced DNA damage in vivo and in vitro were evaluated. Plasmid pcDNA3.0 solution was mixed with heparin-SOD, SOD, and a mixture of heparin and SOD (heparin + SOD), respectively, and irradiated with (60)Co at a dosage of 120 Gy. DNA injury was analyzed using agarose gel electrophoresis. The results showed that the degree of injury of pcDNA3.0 mixed with heparin-SOD, SOD, or heparin + SOD was less than that of untreated pcDNA3.0, and among them the degree of injury of pcDNA3.0 mixed with heparin-SOD was the least. It also showed that the protective effect increased with an increase of heparin-SOD concentration. The effects of SOD and heparin-SOD on the DNA damage and tumor inhibition rate of (60)Co γ-radiation exposure on tumor-bearing mice were also studied. Agarose gel electrophoresis showed that, when different SOD samples were administered before irradiation, the thymus DNA injuries of heparin-SOD, SOD, or heparin + SOD groups were more serious than that of the control group, and the DNA injuries of heparin-SOD or heparin + SOD groups were the most serious, which contradicted the above in vitro experiments. However, when heparin-SOD was administered post irradiation, it showed a repairing effect on the injured DNA.

[Establishment and experimental study of a transplantable hepatocellular carcinoma model in 615-strain mice (H 615)]

H 615, the first transplantable mouse liver carcinoma model established in China, was derived from a spontaneous hepatocellular carcinoma of an inbred 615 mouse and has been successfully propagated for 52 generations during the past 7 years and more. Its biologic and pathologic features are relatively stable. H 615 was a syngenic transplantable tumor model of 615-strain mice with a successful transplantation rate of 85.6% without spontaneous regression. The course of tumor growth after subcutaneous inoculation was divided into 4 stages: latent, slowly growing, rapidly growing and terminal stages. Cancer metastasis was rare. The tumor-bearing host would die of cachexia finally. The mean survival time was 62.2 +/- 11.0 days regardless of sex or age. Histologically and ultrastructurally, H 615 was a well-differentiated hepatocellular carcinoma, rather resembling human liver carcinoma. The short-term primary passage culture of H 615 showed that, in vitro, tumor tissue could easily grow into monolayer, the majority of which appeared as epithelioid cells in cytomorphology. Therapeutic tests of 15 anticancer drugs showed that H 615 was sensitive, in varying degrees, to 5 drugs, i. e. MMC, Thio-Tepa, 5FU, CPT and DACT. The inhibition rate of MMC and Thio-Tepa could be as high as 100%. These experimental results are similar to those of the human liver cancer chemotherapy. Hence, the authors believe that H 615 may be a useful model in experimental study of the liver cancer and screening of anticancer drugs.